Computerized recording of neuromuscular monitoring and the risk of residual paralysis at the time of extubation

Objective: We tested whe ther a newly installed neuromuscular monitoring device (NMT) with a computerized anesthesia recording system, incorporated in all anesthesia stations, could enhance the commitment to objective neuromuscular monitoring in a teaching hospital anesthesia department. Methods: After 6 months of familiarization with the new package, we retrospectively assessed 500 consecutive anesthesia records from our database. The main criteria were the use of the NMT device, the administration of pharmacological reversal, the relaxants regimen, and duration of anesthesia and surgery. Results: A total of 486 anesthesia records were analyzed. The rate of NMT utilization was 72%, while the rate of reversal was of 46%. 4% of patients were both not monitored and not reversed. The NMT was most used on patients having longer surgery. Time delay from reversal injection to extubation was significantly shorter in patients who were not monitored; 9±7 min vs. 16±10 min, P <0.001. Conclusion: Despite the presence of quantitative objective neuromuscular monitoring in all operating rooms, and the automatic data recording system, the rate of monitoring neuromuscular blockade was not high enough to rule out the potential risk of residual paralysis at the time of extubation.